Provider Demographics
NPI:1275195042
Name:SCHWEGERL, ALISA MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:MARIE
Last Name:SCHWEGERL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:MARIE
Other - Last Name:CANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1800 STROH PLACE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-776-6081
Mailing Address - Fax:
Practice Address - Street 1:1800 STROH PLACE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-776-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.00003138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist